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The Problem
“My child is having trouble at school.”
Common Causes
Reading disorder (dyslexia)
Normal variation in rate of learning
Other Causes
Vision problem
KEY FINDINGS
History
Learning disorder
Usually specific problem with reading
Does well in other subjects (math, etc.)
Understands things better when spoken, rather than written
Vision problem
Blurred vision
Double vision
Convergence insufficiency
Examination
Learning disorder
Normal eye examination
Vision problem
Decreased visual acuity
Strabismus
Dry eyes
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The majority of children with reading or other learning disorders do not have vision problems, but they should be evaluated by a pediatric ophthalmologist to rule out this possibility. Parents should be advised against optometric vision therapy because there is no evidence of benefit from this expensive and time-consuming treatment.

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What Shouldn’t Be Missed

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Children with specific reading disorders, such as dyslexia, are usually of normal or above-normal intelligence. They have a specific problem processing written language. Early identification of such problems allows for the development of alternative teaching methods that can maximize the students’ education.

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  • 1. Dyslexia. Children with dyslexia and other reading problems have specific difficulty processing written information. The disorder does not result from eye or ocular tracking problems, but rather from abnormalities in the portions of the cerebral cortex that process written information. Treatment programs based on “vision therapy” are of no benefit in treating this disorder.1,2
  • 2. Vision problems. Very few children with reading problems have primary ocular problems. However, they should be screened for these. Occasionally such children will be found to need glasses or have some form of strabismus or other vision abnormality that impedes reading (Table 23–1).
  • 3. Normal variation in rate of learning. Normal children learn different tasks at different rates. The speed and ease at which children learn to read is quite variable, particularly during kindergarten and first grade. Patients are sometimes referred at this young age for evaluation of possible reading problems. Many of these patients are normal (both visually and cognitively), and will attain normal reading levels as they age.

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Table Graphic Jump Location
Table 23–1. Eye Problems that May Cause Reading Difficulty
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It is important to recognize reading disorders for several reasons. First, affected children often will benefit from alternative educational approaches, such as the use of books on tape rather than written information. Second, the families of such children may seek alternative treatments, such as optometric vision therapy. These evaluations typically result in recommendations for costly and time-consuming treatments, for which there is no scientific evidence of benefit.

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History

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Children with reading disorders are most commonly identified in early grade school. They are usually ...

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